Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 3675849 | AL |
N | 208600000X | Surgeon | 3675849 | AL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME104923 | FL |
NPI | 1093891400 |
---|---|
Provider Name | Michael E Mcclure |
First Address | Orlando, FL 32804-4644 |
Second Address | Orlando, FL 32804-4644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09157347 | (05) | MS |
51592621 | BCBS - 1720 CENTER ST (01) | AL |
51592825 | 575 STANTON RD (01) | AL |
51592834 | 3401 MED PK DR (01) | AL |
51593305 | 2451 FILLINGIM (01) | AL |